HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INE My.ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � � � 2^
Date: Q/ C� "�")�v Permit Number:
1 (] RECEIVED
o FEB 0 9 2021
Building Permit Application Permitting Department
Planning and Development Services St. Lucie county
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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r MENT LOCAT'!ON r...c_",._..r_.�y�w.i�cf.._�, ..ub,.. .s.,,,,u,_,�la.....rk�;;{.4`.`'�..f.oi..�_ 2.?9...te.,--,y_ fir.. Siic. ..t.,. i.• .+:s J,. t4..
Address:_ 66oq S,4"f C 4,+iZA 31-Vo, Fd1L-' Pte-RC& FL , 34g1
Property Tax ID#: 1361 -G U- o3 g6 -64c, /-7 Lot No. 5
Site Plan Name: _1AKe_wooD ?Rkli~ Block No. if&
Project Name:
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New Electrical eter KID econd Electrical Meter /0y
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Additional work to be performed under this permit-check all that apply:
`Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: l2g Sq. Ft. of First Floor: azy
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
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OWN�ER/LESSEE _; f � tt t � CO1TR�i4CTOR � � �� � .a *
a Kx3 . 'P �i Yt k r. t a :..1
Name `7 :YAS Name:
Address: Sr73q r_ a2A Company: 6
City: Foyer State: J�L Address: S�2/ A(
Zip Code:t,3e/9S-J Fax: City: Arius t/e-6g State: )cG
Phone No. 3,30-3,53-fK11 Zip Code:�3Z_146, Fax: ,321-S�7- 193if
E-Mail: `7712iLL<m4A! (F err,�IRiG >�orv/ Phone No ,3Z/ ---5-6 � �R'3 S-
Fill in fee simple Title Holder on next page (if different E-Mail DF,4ico &,)
from the Owner listed above) State or County License 3L78 5'
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPE'MENT L CXONrTtRULTIOfIWNRzT� 3'{iv .
DESIGNER/ENGINEER: Not Applicable ,�_. �. r��v���,�•��...�._��:;.�� -��.-_�.-_�.�.>-� ���
MORTGAGE COMPANY. Not Applicable
Name: Name: —
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures, swimming pools, fences,walls, signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF , I L b C COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
C to
Pr se or Online Notarization Physical Presence or Online Notarization
this(_day of 7 —1,026 by _ this day of 2020 by
T�c,-r a 11ri n �,A ►7 e P -
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificat'IOTNType of Identification
Produced j� Produced
LL,
(Signature of Notary P ic_.. 1 at$afZ1G"a - __, (Signature of Notary Public-State of Florida)
AUDREY B.HUMPI:[,Z( � i
Commission No. :*, h4YC(B��lSION#fCSti't3'S1T Commission No.
(Seal)
`�' o•' EXPIRES:March f . 1
bonded Thru N tary Puh.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.